title: Outcomes among patients discharged from busy intensive care units.
abstract: BACKGROUND
  Strains on the capacities of intensive care units (ICUs) may influence the quality of ICU-to-floor transitions.
  
  
  OBJECTIVE
  To determine how 3 metrics of ICU capacity strain (ICU census, new admissions, and average acuity) measured on days of patient discharges influence ICU length of stay (LOS) and post-ICU discharge outcomes.
  
  
  METHODS
  Retrospective cohort study from 2001 to 2008.
  
  
  METHODS
  155 ICUs in the United States.
  
  
  METHODS
  200 730 adults discharged from ICUs to hospital floors.
  
  
  METHODS
  Associations between ICU capacity strain metrics and discharged patient ICU LOS, 72-hour ICU readmissions, subsequent in-hospital death, post-ICU discharge LOS, and hospital discharge destination.
  
  
  RESULTS
  Increases in the 3 strain variables on the days of ICU discharge were associated with shorter preceding ICU LOS (all P < 0.001) and increased odds of ICU readmissions (all P < 0.050). Going from the 5th to 95th percentiles of strain was associated with a 6.3-hour reduction in ICU LOS (95% CI, 5.3 to 7.3 hours) and a 1.0% increase in the odds of ICU readmission (CI, 0.6% to 1.5%). No strain variable was associated with increased odds of subsequent death, reduced odds of being discharged home from the hospital, or longer total hospital LOS.
  
  
  CONCLUSIONS
  Long-term outcomes could not be measured.
  
  
  CONCLUSIONS
  When ICUs are strained, triage decisions seem to be affected such that patients are discharged from the ICU more quickly and, perhaps consequentially, have slightly greater odds of being readmitted to the ICU. However, short-term patient outcomes are unaffected. These results suggest that bed availability pressures may encourage physicians to discharge patients from the ICU more efficiently and that ICU readmissions are unlikely to be causally related to patient outcomes.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality; National Heart, Lung, and Blood Institute; and Society of Critical Care Medicine.
authors.forename: Jason
authors.initials: J
authors.lastname: Wagner
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Gabler
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Sydney E S
authors.initials: SE
authors.lastname: Brown
authors.forename: Brian L
authors.initials: BL
authors.lastname: Strom
authors.forename: Scott D
authors.initials: SD
authors.lastname: Halpern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D010359:Patient Readmission; D012189:Retrospective Studies; D014218:Triage; D014481:United States